Hussain Tassawar, Salamat Amjad, Farooq Muhammad Asif, Hassan Fayyaz, Hafeez Muhammad
Department of Gastroenterology, Military Hospital, Rawalpindi.
J Coll Physicians Surg Pak. 2009 Apr;19(4):223-7.
To determine common indications for requesting Endoscopic Ultrasound (EUS) and to describe the diagnosis made after endoscopic ultrasound/Fine-Needle Aspiration and Cytology (FNAC) during two years at a tertiary gastrointestinal unit.
Cross-sectional descriptive study.
The study was carried out in Gastrointestinal Department of Military Hospital, Rawalpindi, from March 2006 to February 2008.
One hundred and eighty nine patients who underwent EUS during study period at Military Hospital were included in the study. Patients too ill (hypoxemic/hypotensive) to undergo procedure safely and those with complete esophageal blockage at upper end by tumour not allowing scope/EUS probe to advance beyond were excluded. EUS was done with Olympus Exera EUS 160, linear or radial scope, as required. EUS findings were recorded against indications as enlarged lymph nodes, tumour, staging, normal or incomplete. Fine-Needle Aspiration (FNA) was done as per findings on EUS using 21-22 G needle. An on-site cytopathologist made the provisional cytopathological diagnosis. Final cytology/histopathology report was given after review of slides by consultant histopathologists at Armed Forces Institute of Pathology (AFIP), Rawalpindi, and were documented as tuberculosis, malignancy, chronic pancreatitis or reactive hyperplasia. Data was analyzed for documentation of patients' age, gender, common indications, findings on EUS/FNAC, using SPSS version 10. Percentages and frequencies were calculated for the presence of these above-mentioned variables.
Of the 189 patients, 145 (77%) were male and 44 (23%) female. Age was 18-80 years (mean 49 years). Major indications for referral were lymphadenopathy in 92 (49%), suspected growth pancreas in 57 (28%), growth of stomach in 20 (11%) and a heterogeneous group included esophageal, liver, retroperitoneal masses, rectal and other pathologies. Findings on EUS included lymphadenopathy in 76, mostly in sub-carina and AP window. Mass in pancreas was seen in 36, followed by stomach tumour in 17 and esophagus in 9. FNAC was done in 142 out of 189 patients. Final diagnosis out of 67 FNAC/histopathology of lymph nodes were tuberculosis in 26 and malignant lesions in 23. These included metastatic adenocarcinoma in 8, lymphoproliferative disorder in 7, metastatic squamous cell carcinoma in 5, small cell carcinoma in 2 and anaplastic in 1. Pancreatic tumours were adenocarcinoma in 16, poorly differentiated in 3 and neuroendocrine in 2. Stomach tumours were found in 11, and included lymphomas 5, GIST 3, carcinoids 2, metastatic choriocarcinoma 1 and adenocarcinoma in 1. Therapeutically, 3 celiac blocks and one pancreatic pseudocyst drainage was done.
The main indication of EUS and pathology of mediastinal and celiac nodes were metastatic malignancy and tuberculosis. Pancreatic adenocarcinoma was another common cause for asking EUS.
确定行超声内镜检查（EUS）的常见适应证，并描述在一家三级胃肠病治疗中心两年内超声内镜检查/细针穿刺抽吸及细胞学检查（FNAC）后的诊断结果。
横断面描述性研究。
本研究于2006年3月至2008年2月在拉瓦尔品第军事医院胃肠病科开展。
纳入研究期间在军事医院接受EUS检查的189例患者。病情过重（低氧血症/低血压）无法安全进行该检查的患者，以及肿瘤导致食管上端完全堵塞致使内镜/EUS探头无法推进的患者被排除。根据需要，使用奥林巴斯Exera EUS 160型线性或径向探头进行EUS检查。针对肿大淋巴结、肿瘤、分期、正常或不完整等适应证记录EUS检查结果。根据EUS检查结果，使用21-22G针进行细针穿刺抽吸（FNA）。现场细胞病理学家做出初步细胞病理学诊断。拉瓦尔品第武装部队病理研究所（AFIP）的顾问组织病理学家对玻片进行复查后给出最终细胞学/组织病理学报告，并记录为结核病、恶性肿瘤、慢性胰腺炎或反应性增生。使用SPSS 10版软件分析数据，记录患者的年龄、性别、常见适应证、EUS/FNAC检查结果。计算上述变量存在情况的百分比和频率。
189例患者中，145例（77%）为男性，44例（23%）为女性。年龄在18至80岁之间（平均49岁）。转诊的主要适应证为淋巴结病92例（49%）、疑似胰腺肿物57例（28%）、胃部肿物20例（11%），另一类不同情况包括食管、肝脏、腹膜后肿物、直肠及其他病变。EUS检查结果包括淋巴结病76例，大多位于隆突下和主动脉肺动脉窗。胰腺肿物36例，其次是胃部肿瘤17例，食管肿物9例。189例患者中有142例进行了FNAC。67例淋巴结的FNAC/组织病理学最终诊断中，26例为结核病，23例为恶性病变。其中包括转移性腺癌8例、淋巴增殖性疾病7例、转移性鳞状细胞癌5例、小细胞癌2例、间变性癌1例。胰腺肿瘤中腺癌16例、低分化3例、神经内分泌肿瘤2例。胃部肿瘤11例，包括淋巴瘤5例、胃肠道间质瘤3例、类癌2例、转移性绒毛膜癌1例、腺癌1例。治疗方面，进行了3次腹腔神经丛阻滞和1次胰腺假性囊肿引流。
EUS的主要适应证以及纵隔和腹腔淋巴结的病理情况为转移性恶性肿瘤和结核病。胰腺腺癌是另一个行EUS检查的常见原因。
